Where do we stand with renovascular hypertension?

In a bygone era, secondary hypertension was an easy issue. We had the obligation to investigate all hypertensive patients for secondary causes [1]. Patients identified with secondary hypertension were referred to an appropriate surgeon and the deed was done. After all, back then ‘a chance to cut was a chance to cure’. However, these pastoral times are gone, with the single exception of pheochromocytoma. Evidencebased medicine has chased us away from this lofty goal and we have become slaves to the Cochrane reports and ‘nothing is proved’. Whether or not this attitude is clinically acceptable in any given patient is a debate that clinicians face every day.

[1]  T. Fehr,et al.  Contrast nephropathy: review focusing on prevention. , 2004, Journal of the American College of Cardiology.

[2]  J. V. van Engelshoven,et al.  Accuracy of Computed Tomographic Angiography and Magnetic Resonance Angiography for Diagnosing Renal Artery Stenosis , 2004, Annals of Internal Medicine.

[3]  R. Bersin,et al.  Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. , 2004, JAMA.

[4]  J. Pell,et al.  Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials , 2003, BMJ : British Medical Journal.

[5]  C. Wilcox,et al.  Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis. , 2003, Kidney international.

[6]  C. Carvounis,et al.  Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. , 2002, Kidney international.

[7]  J Waigand,et al.  Determination of renal arterial stenosis severity: comparison of pressure gradient and vessel diameter. , 2001, Radiology.

[8]  M Galanski,et al.  Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. , 2001, The New England journal of medicine.

[9]  P. Krijnen,et al.  The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group. , 2000, The New England journal of medicine.

[10]  Pierre-François Plouin,et al.  Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. Essai Multicentrique Medicaments vs Angioplastie (EMMA) Study Group. , 1998, Hypertension.

[11]  N. Madias,et al.  Captopril-induced functional renal insufficiency in patients with bilateral renal-artery stenoses or renal-artery stenosis in a solitary kidney. , 1983, The New England journal of medicine.

[12]  M. Weinberger,et al.  Diagnosis of secondary forms of hypertension. A comprehensive protocol. , 1977, JAMA.

[13]  H. W. Smith.  Unilateral nephrectomy in hypertensive disease. , 1956, The Journal of urology.